BACKGROUND: Recurrent pregnancy loss (RPL) is a multifactorial condition, with over 50% of cases remaining unexplained. The absence of therapeutic consensus raises questions regarding referral for assisted reproductive technology (ART). OBJECTIVE: To evaluate live birth rates and predictors of success among women with RPL referred to a tertiary ART center. METHODS: We conducted a retrospective cohort study. Women aged 18-42 years with ≥ 3 pregnancy losses before 14 weeks' gestation, referred to the ART center of Amiens-Picardie University Hospital (2014-2022) were included. The primary outcome was achieving a live birth during follow-up. Independent predictors were identified using stepwise logistic regression. RESULTS: Among the 85 women with RPL included (median age 29.6 [8.6] years), 49/85 (57.6%) had no underlying infertility issues, and 36/85 (42.3%) had associated infertility issues. Most women were nulliparous (50/85, 58.8%), and had a median of 3 [1] previous miscarriages. Overall, 64/85 (75.3%) achieved at least one live birth: 33/64 (52%) spontaneously and 31/64 (48%) via ART, with median times to conception of 13.6 [10.5] and 14.2 [10.6] months, respectively. ART use was more frequent among infertile women (≥1 IVF/ICSI cycle: 26/36, 72.2% vs. 17/49, 34.7%; p = 0.001), leading to a higher proportion of medically-assisted conceptions in this group (20/24, 83.3% vs. 11/40, 27.5%; p < 0.001). Diminished ovarian reserve and a higher number of previous miscarriages were independently associated with lower live birth rates (aOR 0.26 [0.08-0.89] and 0.76 [0.53-0.96], respectively). CONCLUSION: Approximately three-quarters of women with RPL achieved a live birth, most after spontaneous conception. ART should be reserved for couples with confirmed infertility or when another underlying cause clearly justifies intervention.